Provider Demographics
NPI:1932249745
Name:TRIPLETT, ELLY DIMOVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLY
Middle Name:DIMOVA
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 FLYNN AVE
Mailing Address - Street 2:APT B
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043
Mailing Address - Country:US
Mailing Address - Phone:650-368-7079
Mailing Address - Fax:650-368-7079
Practice Address - Street 1:114 BIRCH ST
Practice Address - Street 2:SUITE A
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-368-7079
Practice Address - Fax:650-368-7079
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist